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Psychiatry Education Forum Academy Forums General Discussions TCA of choice for panic attacks?

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  • TCA of choice for panic attacks?

  • Dr. Harvinder Singh

    April 27, 2021 at 12:10 pm

    What is your preferred TCA (Tricyclic Antidepressant) for panic attacks management?

    I have few patient not responding to first & second line treatment and I am leaning toward considering TCAs at this time.

  • Carissa Kajenski

    May 5, 2021 at 6:00 am

    I have never prescribed a TCA specifically for panic attacks, but I have had excellent response with amitriptyline for GAD.

    • Dr. Harvinder Singh

      May 5, 2021 at 8:59 am

      I recently tried imipramine at low dose of 10 twice daily (with slow increase to 25 mg twice daily) with good response in two patients.

  • Dr. Harvinder Singh

    May 5, 2021 at 9:56 am

    Rationale behind using Imipramine for panic disorder:

    Based on literature review: among TCAs, Imipramine have >10 RCT showing efficacy for panic disorder followed by Clomipramine (with 5 RCTs).

    Interesting clinical fact from one study is: the effects of imipramine were significantly superior to those of placebo in patients with spontaneous panic attacks, ie, patients with agoraphobia or mixed phobia. In patients with simple phobia, who do not experience spontaneous panic, there was not a significant difference between imipramine and placebo.


    1. Zitrin CM, Klein DF, Woerner MG, Ross DC. Treatment of phobias. I. Comparison of imipramine hydrochloride and placebo. Arch Gen Psychiatry. 1983 Feb;40(2):125-38. (pubmed)
    2. Mavissakalian MR, Perel JM. Long-term maintenance and discontinuation of imipramine therapy in panic disorder with agoraphobia. Arch Gen Psychiatry. 1999 Sep;56(9):821-7. (pubmed)
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0 of 0 posts June 2018